Purpose of review: In general, the initiation of combination antiretroviral (cART) is associated with improvement in cognitive function. However, the impact of cART has on cognitive function in neurologically asymptomatic HIV-infected individuals initiating therapy at high CD4+ lymphocyte cell counts is unknown.
Recent findings: Cognitive function impairment remains prevalent despite effective cART. Several clinical risk factors for this condition have been described, including low nadir CD4+ lymphocyte cell count which may be associated with greater neuroinflammatory process, a potential pathogenic mechanism underlying this cognitive impairment. The earlier initiation of antiretroviral therapy could theoretically avoid this risk factor and limit the degree of neuroinflammation. On the converse, the earlier initiation of cART may be associated with the development of neuronal toxicities.
Summary: This review article highlights the recent literature and arguments for and against the earlier initiation of cART with regards to cognitive function.